The Potential Roles of Pharmacists in the Clinical Implementation of Pharmacogenomics

The field of pharmacogenomics is at the forefront of a healthcare revolution, promising to usher in a new era of precision medicine [...].

The feasibility and functioning of a cooperative circuit, combining hospital and community pharmacists collaborating with geneticists and clinicians in order to adopt clopidogrel pharmacogenetic testing, were assessed in a prospective trial from Spain by Mir and colleagues [37].In addition to improving the circuit's overall utility and patient and healthcare provider satisfaction, this cooperative effort increased some of its operational elements.It also set a positive precedent for future endeavours.
Another prospective single-centre interventional study from the Netherlands by Kerskes and colleagues [38] involving polypharmacy patients with chronic kidney disease evaluated the utility of pharmacogenomic testing in regular medication evaluations.Hospital pharmacists and nephrologists collaboratively conducted pharmacogenomic profiling and automated medication surveillance to identify gene-drug interactions and determine the clinical significance and the need for pharmacotherapeutic interventions.The study demonstrated the potential benefits of optimizing pharmacotherapy for chronic kidney disease patients, suggesting that pharmacogenomic testing could enhance routine medication assessments.
A cross-sectional web-based survey by Hayashi and Bousman [39] conducted in Alberta (a province in Canada) hospitals assessed healthcare providers' (pharmacists, nurse practitioners, and physicians) knowledge, experience, and perceptions of pharmacogenomics.The study found that a significant proportion of the respondents lacked knowledge, training, and exposure to pharmacogenomics.Despite limited knowledge, participants expressed positive attitudes toward the clinical usefulness of pharmacogenomics, particularly in oncology, cardiology, and psychiatry.Barriers to implementation included knowledge gaps, cost considerations, and a lack of guidelines and evidence.The study results provide a guideline for future initiatives in Alberta and other regions in Canada to promote the awareness of the accessibility and reliability of evidence for using pharmacogenomic testing in optimizing patient care.
Stäuble and colleagues [40] from Switzerland developed a structured pharmacogenomic testing and counselling service to be offered by pharmacists based on observational study data.This was in response to the challenging process of integrating pharmacogenomics into clinical practice.The essential components of the pharmacogenomic testing service included patient referrals, pharmacogenomic testing, medication reviews, preand post-test counselling, and follow-up.These steps highlight the importance of interprofessional collaboration among healthcare providers and pharmacists' role in an interprofessional healthcare environment.
A cross-sectional study from Croatia by Bukic and colleagues [41] compared the attitudes of biomedical students in various healthcare branches to the utilization of pharmacogenomics in clinical practice.The students acknowledged the advantages of applying pharmacogenomics in clinical practice and showed a keen interest in its clinical application.The majority of students said that their future practices require the ability to recognize patients who are at risk and could benefit from pharmacogenomic testing.The study emphasized the importance of educational institutes in incorporating more pharmacogenomics education into their curricula and stressed the need for continuing education in pharmacogenomics for healthcare professionals.The study also emphasized that ethical concerns related to the implementation of pharmacogenomics should be addressed and regulated to ensure its appropriate and ethical use in practice.
These international studies have demonstrated the potential roles of pharmacists in the clinical implementation of pharmacogenomics worldwide.We expect the following from pharmacists (adapted from the ASHP position statement [25]) (Figure 1): (1) Pharmacists should lead in the clinical implementation of pharmacogenomics as drug-gene interaction experts.(2) Pharmacists should use pharmacogenomic testing for appropriate patient cases and use the test results to optimize medication therapy.
(3) Pharmacists should be the point of contact for patients and healthcare professionals in terms of interpreting pharmacogenomic test results and providing educational resources.(4) Pharmacists should be able to confidently provide one-to-one consultations on pharmacogenomic test results to their patients.As the global consensus solidifies in favour of pharmacogenomic integration producing optimal patient care, numerous pharmaceutical organizations have begun to advocate for pharmacists to assume leadership in pharmacogenomic service implementation.Pharmacists' roles will increasingly evolve into patient education as prescribers and patients become more familiar with pharmacogenomic testing.Therefore, enhancing pharmacist education must bridge the knowledge gap and bolster confidence in counselling patients or discussing pharmacogenomic test results with other healthcare professionals.As the global consensus solidifies in favour of pharmacogenomic integration producing optimal patient care, numerous pharmaceutical organizations have begun to advocate for pharmacists to assume leadership in pharmacogenomic service implementation.Pharmacists' roles will increasingly evolve into patient education as prescribers and patients become more familiar with pharmacogenomic testing.Therefore, enhancing pharmacist education must bridge the knowledge gap and bolster confidence in counselling patients or discussing pharmacogenomic test results with other healthcare professionals.

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Pharmacists must collaborate with healthcare providers from multiple disciplines, such as physicians, nurses, or genetic counsellors, to ensure their patients receive the best possible care.(6) Pharmacists should be involved in pharmacogenomics research and facilitate the development of clinical practice guidelines.(7) Pharmacists should guide implementation efforts and educate healthcare professionals in the adoption of pharmacogenomic testing globally.Pharmacy 2023, 11, x FOR PEER REVIEW 3 of Pharmacists should be the point of contact for patients and healthcare professionals in terms of interpreting pharmacogenomic test results and providing educational resources.(4) Pharmacists should be able to confidently provide one-to-one consultations on pharmacogenomic test results to their patients.(5) Pharmacists must collaborate with healthcare providers from multiple disciplines, such as physicians, nurses, or genetic counsellors, to ensure their patients receive the best possible care.(6) Pharmacists should be involved in pharmacogenomics research and facilitate the development of clinical practice guidelines.(7) Pharmacists should guide implementation efforts and educate healthcare professionals in the adoption of pharmacogenomic testing globally.

Figure 1 .
Figure 1.The potential roles of pharmacists in clinical pharmacogenomics.

Figure 1 .
Figure 1.The potential roles of pharmacists in clinical pharmacogenomics.